CMS to Keep $750 Recovery Threshold & Announces Upcoming Webinar on MSPRP Enhancement

November 29, 2018

$750 Threshold on Reporting and Conditional Payment Recovery Maintained

In a 11/15/2018 Alert, CMS announced that the 2019 recovery threshold for liability, no-fault and workers’ compensation settlements will remain at $750. Accordingly, Total Payment Obligations to the Claimant, TPOCs, in the amount of $750 or less are not required to be reported to CMS through the Section 111 Mandatory Reporting process, nor will CMS attempt to recover conditional payments for TPOCs of this amount.

By way of background, pursuant to the SMART Act of 2012, CMS is required to annually determine a threshold amount such that the cost of collection does not outstrip the amount recovered through such collection efforts. CMS’s calculations, which can be found here, resulted in the $750 threshold being maintained.

Upcoming Webinar on MSPRP Self-Reporting Enhancement

CMS also recently announced it will hold a webinar on 12/18/2018 at 1 p.m. ET to provide an overview of the self-reporting functionality that will be added to the Medicare Secondary Payer Recovery Portal (MSPRP) as of 1/7/2019. The webinar invite can be found here.

Self-reporting refers to reporting a no-fault, workers’ compensation or liability claim to CMS’s Benefits Coordination and Recovery Center (BCRC) which is typically the first step in identifying whether conditional payments have been made by Medicare in the claim. Presently, reporting can be done via phone, fax, mail or through the Section 111 mandatory insurer reporting process.

The so-called “lead” which results from this reporting is utilized by CMS’s recovery contractors, the BCRC or the Commercial Repayment Center (CRC) to investigate payments made by Medicare for the reported diagnosis and seek recovery for conditional payments made for the diagnosis. It is anticipated the expansion of self-reporting to the MSPRP will assist in expediting the Medicare conditional payment investigation process and perhaps improve the accuracy of charges identified as conditional payments.

Practical Implications

As CMS is keeping the $750 threshold for mandatory reporting and conditional payment recovery there are no changes to the reporting processes or determinations as to when conditional payment should be investigated or resolved.

In regard to the self-reporting enhancement to the MSPRP, as noted above, we believe this may improve the speed and accuracy of the Medicare conditional payment process. We will provide further information following the December 18 webinar.

Connect with Tower at NWCDC 2018

November 27, 2018

banner for 2018 National Workers Compensation and Disability Conference

Our numbers speak for themselves. Challenging conventional methodologies, we pursue the best path to settlement with innovative solutions, like MSA Optimization, Simplified Medicare Conditional Payment Resolution, and Legacy Claim Settlement Initiatives.

Do you know your numbers?

What is the percentage of your CMS-approved MSAs which include prescription medication?

How often are opioids included in your MSAs?

What percentage of counter-higher MSAs are submitted for a re-review to CMS and how successful are those re-reviews?

What is the success rate for appealing Medicare conditional payment demands?

Without such benchmark analytics, it is difficult to measure the cost-effectiveness of your MSP compliance program and ways to better optimize your program.  Tower constantly defines, measures and manages the metrics that yield the best balance in care, cost, and compliance.

We have a variety of interventions that will optimize your claims outcomes — many at no additional charge. If the numbers above don’t convince you, then perhaps you need another number that will — 5420.

Visit us at Booth 5420 to learn more about what Tower MSA Partners can do for you. 

 

Tower Opinions Sought

November 5, 2018

Tower’s expertise on MSP compliance and MSAs was reinforced by some good coverage last week.  Ametros sought the insight of our CEO Rita Wilson for its blog post “About the Evolution of Professional Administration,” which can be found here.  And, WorkCompCentral’s Elaine Goodman interviewed Chief Compliance Officer Dan Anders for her 10/31/2018 story, “CMS Shift on Lyrica Causing MSA Cost Concerns” available by subscription here.